Interventional Spine and Pain Associates Brazos Valley PLLC

Primary specialty

Pain Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081P2900X

Legal business name

INTERVENTIONAL SPINE AND PAIN ASSOCIATES BRAZOS VALLEY PLLC

Practice address

3106 Texas Ave S
College Station, TX 77845-5050

Phone

(979) 985-5489

Fax

(979) 985-5489

NPI assigned

May 6, 2022

Last updated

Aug 17, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ryan Whitmer, DONPI 1508391699

Title

President

Phone

(903) 987-4909

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ryan Whitmer, D.O.

  • Physical Medicine & Rehabilitation Physician
  • College Station, TX
  • NPI 1508391699
  Authorized official Same address or phone
• Jacqualyn Sequeira Faigle, FNP

  • Family Nurse Practitioner
  • Brenham, TX
  • NPI 1487262143
  NPD
• Mukund I Gundanna, MD

  • Orthopaedic Surgery Physician
  • College Station, TX
  • NPI 1730156811
  NPD
• Danielle Maxine Prince, PA-C

  • Physician Assistant
  • College Station, TX
  • NPI 1518887348
  NPD (past)
• Stephanie Karam Whitmer

  • Family Nurse Practitioner
  • College Station, TX
  • NPI 1770284580
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1651795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660694400000",
    "number": "1568108249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3106 TEXAS AVE S",
            "city": "COLLEGE STATION",
            "state": "TX",
            "postal_code": "778455050",
            "telephone_number": "979-985-5489",
            "fax_number": "979-985-5489"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3106 TEXAS AVE S",
            "city": "COLLEGE STATION",
            "state": "TX",
            "postal_code": "778455050",
            "telephone_number": "979-985-5489",
            "fax_number": "979-985-5489"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERVENTIONAL SPINE AND PAIN ASSOCIATES BRAZOS VALLEY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-06",
        "last_updated": "2022-08-17",
        "certification_date": "2022-08-17",
        "status": "A",
        "authorized_official_last_name": "WHITMER",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "903-987-4909",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "2081P2900X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stacey Lynn Ingram, FNP
• Lauren Elizabeth Innis
• Insight Mental Health
• Inspire Physical Therapy
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• Basma Iskandarani, APN-CRNA
• Island Medical College Station, PLLC
• Island Medical Hospitalist College Station, PLLC
• Nazish Ismail, FNP
• Iyabode Ogunlade, MD PA

• Pain Medicine (Physical Medicine & Rehabilitation) Physician in College Station, TX
• Providers in College Station, TX by specialty
• Pain Medicine (Physical Medicine & Rehabilitation) Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.